1
|
Kelleher DP, Barwise AK, Robbins KA, Borah BJ. Examining the association between professional language interpreter services and intensive care unit utilization among patients with non-English language preference: Evidence from a large U.S. hospital. PATIENT EDUCATION AND COUNSELING 2024; 128:108375. [PMID: 39079432 DOI: 10.1016/j.pec.2024.108375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To examine the healthcare utilization of patients with non-English language preference (NELP) who utilized a professional language interpreter (PLI) in the intensive care unit (ICU) compared to similar patients with NELP who did not utilize a PLI in the ICU. METHODS Single center cohort study of patients with NELP with at least one ICU admission a large academic medical center in the U.S. Midwest (1/1/2008-12/31/2022). The first model examined ICU length-of-stay (LOS) using a negative binomial and the second model examined whether a patient was readmitted to the ICU using a logistic regression with each model controlling for PLI utilization and covariates. RESULTS Patients with NELP who utilized a PLI in the ICU had 0.87-days longer in the ICU (p < 0.01) and had a 46 % decreased odds of being readmitted to the ICU (p < 0.01) than a comparable patient with NELP who did not utilize a PLI in the ICU. CONCLUSION Providing patients with NELP with access to a PLI in the ICU can improve patient outcomes and reduce language barriers. PRACTICE IMPLICATIONS These results can provide the justification to potentially increase PLI staffing levels or increase the access to existing PLIs for more patients with NELP in ICUs.
Collapse
Affiliation(s)
- Dan P Kelleher
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Bioethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Kellie A Robbins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
2
|
Morris AA, Masoudi FA, Abdullah AR, Banerjee A, Brewer LC, Commodore-Mensah Y, Cram P, DeSilvey SC, Hines AL, Ibrahim NE, Jackson EA, Joynt Maddox KE, Makaryus AN, Piña IL, Rodriguez-Monserrate CP, Roger VL, Thorpe FF, Williams KA. 2024 ACC/AHA Key Data Elements and Definitions for Social Determinants of Health in Cardiology: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Data Standards. J Am Coll Cardiol 2024; 84:e109-e226. [PMID: 39207317 DOI: 10.1016/j.jacc.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
|
3
|
Xu N, Sun BJ, Yue TM, Lee B. Factors Predicting Readmission and Mortality in Patients Admitted for Malignant Bowel Obstruction. Am Surg 2024; 90:2570-2576. [PMID: 38676624 DOI: 10.1177/00031348241250045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Malignant bowel obstruction (MBO) is a common complication of patients with advanced malignancies and has poor prognosis. Currently, there are limited guidelines for MBO management or predicting outcomes for these patients. OBJECTIVE To identify patient factors associated with readmission and mortality after hospital admission for MBO. PARTICIPANTS A 5-year retrospective review was performed from 2017 to 2022 at a single tertiary institution to evaluate patients admitted for MBO. All patients had advanced cancer of gastrointestinal or gynecologic primary. Patient demographics, socioeconomic factors, tumor characteristics, and inpatient outcomes were collected. Multivariable analyses were performed to determine variables predicting hospital readmission for recurrent MBO and 90-day mortality. RESULTS 210 patients were included. Mean age was 61 years, 28% were male, and 19% did not primarily speak English. 35% of patients lived over 50 miles from the hospital. On multivariable analysis, non-English speaking patients exhibited increased risk of readmission for MBO (OR = 2.82, P = .039). Older age was associated with decreased risk for MBO readmission (OR = .96, P = .007). Ascites was associated with increased mortality (OR = 2.17, P = .043). Earlier palliative care (PC) consultation predicted decreased readmission (OR = .24, P < .001) yet increased mortality at 90 days (OR = 3.20, P = .003). CONCLUSION Patient age, primary language, and PC consult were predictors for MBO readmission, which may impact 90-day mortality. Given the palliative nature of MBO, modifiable factors such as PC consultation and multidisciplinary goals of care discussions should be prioritized in order to reduce readmissions and focus on quality of life (QOL) for this patient population.
Collapse
Affiliation(s)
- Nova Xu
- Stanford University School of Medicine, Stanford, CA, USA
| | - Beatrice J Sun
- Section of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Tiffany M Yue
- Stanford University School of Medicine, Stanford, CA, USA
| | - Byrne Lee
- Section of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
4
|
Blegen MB, Zingmond DS, Jackson NJ, Torres JR, Russell TA, Maggard-Gibbons M, Russell MM. Association of non-English language preference with postoperative hospital visits among California Medicaid enrollees. Surgery 2024:S0039-6060(24)00595-6. [PMID: 39304449 DOI: 10.1016/j.surg.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/13/2024] [Accepted: 08/17/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Patients with non-English language preference encounter language barriers across phases of surgical care. Patients with a non-English language preference represent 35% of California households and are disproportionately insured by Medicaid. To determine whether language predicts surgical outcomes, we investigated the association of patient non-English language preference with postoperative emergency department visits and readmissions among California Medicaid enrollees. METHODS Our retrospective analysis of adult Medicaid enrollees undergoing 1 of 10 common inpatient operations using California hospital administrative data (2016-2019) modeled the association between non-English language preference and 30-day postoperative emergency department visits and readmissions using mixed effects logistic regression with hospital random intercept, adjusting for patient, operation, hospital, and community characteristics. Secondary analyses stratified by operation urgency and by insurance type in an all-payor cohort. RESULTS Of 115,527 Medicaid enrollees, 17.2% had non-English language preference (n = 19,881), 66% were female (n = 73,653), and 40% were Hispanic/Latino (n = 45,541). Patients with non-English language preference experienced fewer postoperative emergency department visits (non-English language preference: 13.5%, English preference: 17.9%, P < .001) and readmissions (non-English language preference: 7.5%, English preference: 8.5%, P < .001), which persisted in adjusted models (adjusted odds ratio emergency department, 0.80, 95% confidence interval, 0.77-0.85; readmissions: adjusted odds ratio, 0.86, 95% confidence interval, 0.80-0.92). Non-English language preference was associated with fewer emergency department visits after elective (adjusted odds ratio, 0.80; 95% confidence interval, 0.73-0.88) and urgent/emergent surgery (adjusted odds ratio, 0.80; 95% confidence interval, 0.75-0.85) but not readmissions after elective surgery (adjusted odds ratio, 0.89; 95% confidence interval, 0.78-1.01). This pattern was only observed for Medicaid and not other insurance types. CONCLUSION Patients with non-English language preference who receive Medicaid have fewer postoperative emergency department visits and readmissions, even after urgent surgery. Our findings suggest that patterns of health care seeking after surgery vary by patient language, and investigating explanatory mechanisms is needed.
Collapse
Affiliation(s)
- Mariah B Blegen
- Veterans Health Administration, Greater Los Angeles Healthcare System, CA; Department of Surgery, David Geffen School of Medicine at UCLA, CA; National Clinician Scholars Program, University of California, Los Angeles, CA
| | - David S Zingmond
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Nicholas J Jackson
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jesus R Torres
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, CA
| | - Tara A Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, CA
| | - Melinda Maggard-Gibbons
- Veterans Health Administration, Greater Los Angeles Healthcare System, CA; Department of Surgery, David Geffen School of Medicine at UCLA, CA; Olive View-UCLA Medical Center, Sylmar, CA
| | - Marcia M Russell
- Veterans Health Administration, Greater Los Angeles Healthcare System, CA; Department of Surgery, David Geffen School of Medicine at UCLA, CA.
| |
Collapse
|
5
|
Brandt C, Vo JB, Gierach GL, Cheng I, Torres VN, Lawrence WR, McCullough LE, Veiga LHS, Berrington de González A, Ramin C. Second primary cancer risks according to race and ethnicity among U.S. breast cancer survivors. Int J Cancer 2024; 155:996-1006. [PMID: 38685564 PMCID: PMC11250897 DOI: 10.1002/ijc.34971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024]
Abstract
Breast cancer survivors have an increased risk of developing second primary cancers, yet risks by race and ethnicity have not been comprehensively described. We evaluated second primary cancer risks among 717,335 women diagnosed with first primary breast cancer (aged 20-84 years and survived ≥1-year) in the SEER registries using standardized incidence ratios (SIRs; observed/expected). SIRs were estimated by race and ethnicity compared with the racial- and ethnic-matched general population, and further stratified by clinical characteristics of the index breast cancer. Poisson regression was used to test for heterogeneity by race and ethnicity. SIRs for second primary cancer differed by race and ethnicity with the highest risks observed among non-Hispanic/Latina Asian American, Native Hawaiian, or other Pacific Islander (AANHPI), non-Hispanic/Latina Black (Black), and Hispanic/Latina (Latina) survivors and attenuated risk among non-Hispanic/Latina White (White) survivors (SIRAANHPI = 1.49, 95% CI = 1.44-1.54; SIRBlack = 1.41, 95% CI = 1.37-1.45; SIRLatina = 1.45, 95% CI = 1.41-1.49; SIRWhite = 1.09, 95% CI = 1.08-1.10; p-heterogeneity<.001). SIRs were particularly elevated among AANHPI, Black, and Latina survivors diagnosed with an index breast cancer before age 50 (SIRs range = 1.88-2.19) or with estrogen receptor-negative tumors (SIRs range = 1.60-1.94). Heterogeneity by race and ethnicity was observed for 16/27 site-specific second cancers (all p-heterogeneity's < .05) with markedly elevated risks among AANHPI, Black, and Latina survivors for acute myeloid and acute non-lymphocytic leukemia (SIRs range = 2.68-3.15) and cancers of the contralateral breast (SIRs range = 2.60-3.01) and salivary gland (SIRs range = 2.03-3.96). We observed striking racial and ethnic differences in second cancer risk among breast cancer survivors. Additional research is needed to inform targeted approaches for early detection strategies and treatment to reduce these racial and ethnic disparities.
Collapse
Affiliation(s)
- Carolyn Brandt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, California, USA
| | - Vanessa N Torres
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Cody Ramin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
6
|
Hargrave AS, Dawson-Rose C, Schillinger D, Ng F, Valdez J, Rodriguez A, Cuca YP, Bakken EH, Kimberg L. In their own words: Perspectives of IPV survivors on obtaining support within the healthcare system. PLoS One 2024; 19:e0310043. [PMID: 39240948 PMCID: PMC11379214 DOI: 10.1371/journal.pone.0310043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 08/21/2024] [Indexed: 09/08/2024] Open
Abstract
BACKGROUND Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system. METHODS We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory. FINDINGS We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships. CONCLUSIONS Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers.
Collapse
Affiliation(s)
- Anita S Hargrave
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
- Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Dean Schillinger
- Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco (UCSF), San Francisco, California, United States of America
- Division of General Internal Medicine, Center for Vulnerable Populations, University of California San Francisco (UCSF), San Francisco, California, United States of America
- UCSF Institute for Health Policy Studies, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Fiona Ng
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Jessica Valdez
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Amanda Rodriguez
- Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Yvette P Cuca
- Department of Community Health Systems, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - E Hayes Bakken
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Leigh Kimberg
- Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco (UCSF), San Francisco, California, United States of America
| |
Collapse
|
7
|
Coco L, Leon K, Navarro C, Piper R, Carvajal S, Marrone N. "Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services. Ear Hear 2024; 45:1191-1201. [PMID: 38812073 PMCID: PMC11333189 DOI: 10.1097/aud.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. DESIGN Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). RESULTS Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. CONCLUSIONS Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.
Collapse
Affiliation(s)
- Laura Coco
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ
| | - Kimberly Leon
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ
- Department of Psychology, University of Arizona, Tucson, AZ
| | | | - Rosie Piper
- Mariposa Community Health Center, Nogales, AZ
| | - Scott Carvajal
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ
| |
Collapse
|
8
|
Chandrashekar P, Rodriguez JA, Ganguli I. Association of Limited English Proficiency Status and Visit Accompaniment with Quality of Care in the Primary Care Setting. J Gen Intern Med 2024; 39:2358-2361. [PMID: 38831246 PMCID: PMC11347543 DOI: 10.1007/s11606-024-08828-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024]
Affiliation(s)
| | - Jorge A Rodriguez
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Ishani Ganguli
- Harvard Medical School, Boston, MA, USA.
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
9
|
O'Donoghue AL, Dechen T, O'Donoghue SC. Health Equities with Limited English Proficiency: A Review of the Literature. Crit Care Nurs Clin North Am 2024; 36:407-413. [PMID: 39069359 DOI: 10.1016/j.cnc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Health equity exists when everyone has an equal opportunity to achieve their highest level of health. Effective communication is essential to ensure a therapeutic relationship. Patients with limited English proficiency (LEP) experience communication barriers, leading to poorer outcomes. Federal regulation requires hospitals to provide medically trained interpreters; however, this does not always occur. We identified 3 broad areas of research: communication barriers, outcomes, and costs. Findings highlight the challenges patients with LEP face in the health-care system, and the need for targeted interventions to enhance language access, improve cultural competence among health-care professionals, and ensure equitable outcomes for all.
Collapse
Affiliation(s)
- Ashley L O'Donoghue
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Tenzin Dechen
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Sharon C O'Donoghue
- Lois E. Silverman Department of Nursing, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| |
Collapse
|
10
|
Douglas NF, Wallace SE, Cheng CI, Mayer NC, Hickey E, Minick K. A Role for Health Literacy in Protecting People With Limited English Proficiency Against Falling: A Retrospective, Cohort Study. Arch Phys Med Rehabil 2024:S0003-9993(24)01192-4. [PMID: 39218243 DOI: 10.1016/j.apmr.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/26/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To identify risk factors related to falls within the scope of speech-language pathology (SLP) using assessments from the Inpatient Rehabilitation Facility-Patient Assessment Instrument over a 4-month period in 4 inpatient rehabilitation facilities (IRFs). DESIGN Observational retrospective cohort study. SETTING Four IRFs as part of a larger learning health system. PARTICIPANTS Adults aged ≥18 years admitted to the IRFs from October 1, 2022 to February 28, 2023 were included. INTERVENTION N/A. MAIN OUTCOME MEASURES Occurrence of falls. RESULTS Analyses of 631 patient records revealed that the odds of falling were almost 3 times greater in people with limited English proficiency than in English speakers (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.09-6.85). People with limited English proficiency who reported poorer health literacy had 4 times higher odds of falling (OR, 3.90; 95% CI, 1.13-13.44) than English speakers who reported adequate health literacy. People with limited English proficiency who reported adequate health literacy had the same risk of falling as English speakers (OR, 0.98; 95% CI, 0.16-6.12), suggesting the protective role of health literacy for people with limited English proficiency. CONCLUSIONS Language barriers have a significant effect on falls among patients in IRFs. SLPs improving health literacy and providing language support may play a crucial role in mitigating fall risk, thereby enhancing patient safety and outcomes.
Collapse
Affiliation(s)
- Natalie F Douglas
- Department of Communication Sciences and Disorders, The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Mount Pleasant, MI.
| | - Sarah E Wallace
- Department of Communication Sciences & Disorders, University of Pittsburgh, Pittsburgh, PA
| | - Chin-I Cheng
- Department of Statistics, Actuarial, and Data Sciences, College of Science and Engineering, Central Michigan University, Mount Pleasant, MI
| | | | - Ellen Hickey
- School of Communication Sciences and Disorders, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada
| | - Kate Minick
- Rehabilitation Services, Intermountain Health, Salt Lake City, UT
| |
Collapse
|
11
|
Nguyen NV, Guillen Lozoya AH, Caruso MA, Capetillo Porraz MGD, Pacheco-Spann LM, Allyse MA, Barwise AK. Through the eyes of Spanish-speaking patients, caregivers, and community leaders: a qualitative study on the in-patient hospital experience. Int J Equity Health 2024; 23:164. [PMID: 39164755 PMCID: PMC11337574 DOI: 10.1186/s12939-024-02246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/05/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Spanish-speakers with non-English language preference and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Communication challenges during prolonged hospitalizations for complex illnesses negatively influence how this group engages in their care and decision-making while hospitalized. Limited literature capturing the perspectives of Spanish-speaking patients in this context exists. Given the impact of language barriers on care and medical decision-making, this study documents the experiences of Spanish-speaking patients with NELP and hospitalized with complex care needs as well as caregivers and community leaders. METHODS Using community-engaged recruitment strategies and semi-structured interviews and a focus group, we gathered insights from Spanish-speaking patients hospitalized for prolonged periods, caregivers, and community leaders from three geographic regions. Data were deidentified, transcribed, translated, coded in duplicate, and analyzed guided by grounded theory using NVivo. RESULTS We interviewed 40 participants: 27 patients, 10 caregivers and 3 community leaders. We identified four major themes: (1) Disconnected experiences impeding interactions, communication, and decision-making (2) Inadequate interpreter services (3) Benefits and consequences of family at the bedside (4) Community -informed recommendations. CONCLUSION The study showed that in-person interpreters were preferred to virtual interpreters; yet interpreter access was suboptimal. This resulted in ad hoc family interpretation. Participants noted language negatively impacted patient's hospital experience, including decreasing confidence in medical decision-making. Recommendations from patients, caregivers, and community leaders included expanding interpreter access, bolstering interpreter quality and accuracy, and increasing resources for patient education.
Collapse
Affiliation(s)
| | | | - Maria A Caruso
- Community Based Research, Mayo Clinic, Jacksonville, FL, USA
| | | | - Laura M Pacheco-Spann
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
12
|
Martínez Pérez AM, Balcazar FE, Orellano-Colón EM. Marginalized voices: a qualitative exploration of multilevel environmental barriers to assistive technology use among hispanics. Disabil Rehabil Assist Technol 2024:1-12. [PMID: 39158208 DOI: 10.1080/17483107.2024.2392852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/25/2024] [Accepted: 08/10/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE Assistive technology (AT) can increase or maintain the quality of life and overall well-being of people with disabilities. Nevertheless, access to AT is limited among Hispanics with disabilities in the United States (U.S.). AT research representing the experiences of Hispanics is limited, potentially leading to disparities in AT use. Moreover, poor inclusion of Hispanics neglects the needs of this population, resulting in discrepancies in research, practice, and policy related to AT. To address these limitations, this study aimed to identify and explore multilevel environmental barriers to AT use among a sample of Hispanics in the U.S. METHODS This was a descriptive qualitative research design study guided by the Social Ecological Model framework using in-depth interviews to collect data. Nine Hispanic individuals with disabilities and their caregivers who received AT services at the University of Illinois at Chicago Assistive Technology Unit outpatient clinic were interviewed. Data was analyzed using a qualitative thematic analysis approach. RESULTS Barriers to AT use were found to exist in all levels of the Social Ecological Model. The most common barriers to AT use were identified in the community domain, which was related to the lack of AT information, and in the societal domain, which was related to sociocultural norms and the availability of AT funding, policies, and regulations. CONCLUSIONS The participants' lived experiences and perspectives underscored that environmental barriers to AT use are not isolated occurrences; rather, systemic attitudes permeate across all levels of the Social Ecological Model.
Collapse
Affiliation(s)
- Angélica M Martínez Pérez
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fabricio E Balcazar
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Elsa M Orellano-Colón
- Occupational Therapy Program, School of Health Professions, University of Puerto Rico, San Juan, Puerto Rico, USA
| |
Collapse
|
13
|
Butler HM, Bazan M, Rivera L, Salinas KE, Hacker MR, DeLevie-Orey S, Siegel MR, Larson E, Molina RL. Prenatal Care Clinician Preferences Among Patients With Spanish-Preferred Language. Obstet Gynecol 2024:00006250-990000000-01130. [PMID: 39147367 DOI: 10.1097/aog.0000000000005697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/28/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To measure what patients with Spanish language preference and limited English proficiency value most when selecting a prenatal care clinician. METHODS A discrete choice experiment was administered at two large academic medical centers in Boston, Massachusetts. Participants were identified by electronic medical record, had preferred Spanish language and self-identified limited English proficiency, and either were pregnant with a completed fetal anatomy scan or had given birth within the past 12 months at the time of the study. The discrete choice experiment consisted of eight attributes to consider when selecting a prenatal care clinician: clinician Spanish proficiency, type of interpreter used, interpersonal dynamics (ie, making patients feel seen, heard, and cared for), cultural concordance, continuity of care, shared decision making, distance from home, and wait times for appointments. Descriptive statistics of demographic variables were calculated. Hierarchical Bayesian models were used to analyze discrete choice experiment data. RESULTS The attributes that were most important to 166 participants when choosing their prenatal care clinician were interpersonal dynamics within the patient-clinician dyad and clinician Spanish language proficiency (average importance 21.4/100 and 20.8/100, respectively). Of lowest importance were wait time to receive an appointment and continuity of care (average importance 5.1 and 6.1, respectively). Although participants highly preferred that their clinician be "fluent or near fluent in Spanish," the second most preferred option was having a clinician with only basic Spanish proficiency rather than a more advanced level of Spanish proficiency with some misunderstandings. CONCLUSION Our study demonstrates the importance of positive clinician-patient interpersonal dynamics and language-concordant care for patients with Spanish language preference in prenatal care. Promoting equitable patient-centered care for patients with limited English proficiency requires responding to preferences regarding clinician language proficiency and demonstrating attentiveness, empathy, and concern for prenatal care experiences.
Collapse
Affiliation(s)
- Haylie M Butler
- Harvard Medical School, the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Universidad Científica del Sur, Lima, Perú
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Dogar ME, Dacier BM, Mora J, Nicholson S, Scott JA, Haider AH, Flores EJ, Ortega G. Applying Cultural Dexterity to Patients in Radiology. J Am Coll Radiol 2024:S1546-1440(24)00681-1. [PMID: 39117184 DOI: 10.1016/j.jacr.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024]
Affiliation(s)
| | - Brittany M Dacier
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussets; Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Javier Mora
- Harvard Radiation Oncology Program, Boston, Massachussets
| | - Showly Nicholson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussets
| | - Jinel A Scott
- Chief Quality Officer and Associate Chief Medical Officer, Department of Radiology, State University of New York Downstate Health Sciences University and NYC Health and Hospitals/ Kings County, New York, New York
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussets; Dean of Aga Khan University, Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Efren J Flores
- Vice Chair for Radiology, Co-Chair RSNA Health Equity Committee, JACR Associate Editor, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gezzer Ortega
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Co-Founder of the Latino Surgical Society and Lead Faculty for Research and Innovation for Equitable Surgical Care at the CSPH, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussets.
| |
Collapse
|
15
|
Smith KM, Rogers CR, Akinola OO, Yen RW, Holbert NA, Blunt HB. The impact of limited English proficiency on oncological outcomes in the United States: A systematic review. J Eval Clin Pract 2024. [PMID: 39073186 DOI: 10.1111/jep.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The increasing number of immigrants in the United States (U.S.) has resulted in more patients with limited English proficiency (LEP). LEP contributes to patient-provider language discordance, which may impact oncologic health outcomes. OBJECTIVES To assess the effects of LEP compared to English proficiency (EP) for oncological outcomes in adult cancer patients in the United States. SEARCH METHODS We searched MEDLINE (Ovid), the Cochrane Library (Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials), PsycINFO, CINAHL and Scopus from data inception to 26 January 2023. We also searched the reference lists and cited lists of included studies. Studies were limited to the United States and the English language. SELECTION CRITERIA We included retrospective and cross-sectional studies that analyzed one or more clinical outcomes (survival, readmission, length of stay, complications and discharge disposition) in LEP and EP cancer patients. Studies were eligible if they assessed cancer patients in the United States who were 18 years and older. DATA COLLECTION AND ANALYSIS Using a piloted, standardized data collection form, two non-blinded, independent reviewers extracted data in duplicate from studies meeting our inclusion criteria. Reviewers resolved discrepancies through discussion. We then performed a qualitative assessment of the findings. MAIN RESULTS We retrieved 2425 records from the database searches. We screened 1496 records by title and abstract and reviewed the full text of eight records. We retrieved 347 records from additional search methods and reviewed the full text of six records. We included 14 papers in total for analysis. The studies included 55,141 total patients and assessed outcomes in brain, oesophageal, head and neck, pancreatic and skin cancer. Our qualitative assessment demonstrated limited information on whether LEP impacted survival, complications and discharge disposition. We found no significant association between LEP and readmission or length of stay. CONCLUSIONS Studies assessing the impact of LEP and EP on the health outcomes of cancer patients are sparse and inconsistent in the measurements of outcomes and data reporting. The inconclusiveness of our study indicates that further standardized research is needed to assess the impact of LEP on the outcomes of cancer patients in the United States.
Collapse
Affiliation(s)
- Kierstyn M Smith
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Camille R Rogers
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Olawale O Akinola
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Renata W Yen
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Natalie A Holbert
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Heather B Blunt
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| |
Collapse
|
16
|
Plys E, Giraldo-Santiago N, Ehmann M, Brewer J, Presciutti AM, Rush C, McDermott K, Greenberg J, Ritchie C, Vranceanu AM. "They really trust us!": Medical Interpreter's Roles and Experiences in an Integrated Primary Care Clinic. SOCIAL WORK IN MENTAL HEALTH 2024; 22:715-733. [PMID: 39157005 PMCID: PMC11326538 DOI: 10.1080/15332985.2024.2379455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
This study describes medical interpreters' experiences with behavioral health (BH) services in a primary care clinic. Focus group data with medical interpreters representing multiple languages was analyzed using hybrid inductive-deductive thematic analysis. Themes related to interpreter roles were: (1) case management, (2) patient-interpreter relationship, and (3) patient-provider liaison. Themes related to barriers and facilitators to interpreter-mediated BH care were: (1) cultural factors, (2) patient-provider interactions, (3) BH-specific considerations, and (4) clinic factors. Results illustrate ways that interpreters directly (e.g., interpreter-mediated services) and indirectly (e.g., relationship building) support care. The interpreter-patient relationship reportedly helped improve patient attitudes and buy-in for BH.
Collapse
Affiliation(s)
- Evan Plys
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - Natalia Giraldo-Santiago
- Department of Psychiatry, Massachusetts General Hospital
- Department of Medicine, Massachusetts General Hospital
| | - Madison Ehmann
- Department of Psychiatry, Massachusetts General Hospital
| | - Julie Brewer
- Department of Psychiatry, Massachusetts General Hospital
| | | | - Christina Rush
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - Katherine McDermott
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - Jonathan Greenberg
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| | - Christine Ritchie
- Harvard Medical School
- Department of Medicine, Massachusetts General Hospital
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
| |
Collapse
|
17
|
Chwa JS, Bradley AS, Szokol J, Dhillon AK, Luan-Erfe BM. Challenges in Assessment and Management of Postoperative Agitation and Delirium in a Stroke Patient with Limited English Proficiency: Case Report. A A Pract 2024; 18:e01811. [PMID: 38976513 DOI: 10.1213/xaa.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
While Title VI of the Civil Rights Act of 1964 mandates use of interpreters for patients with limited English proficiency, significant disparities persist in intensive postsurgical care. We present the case of a 60-year-old Vietnamese-speaking man with a Type A aortic dissection requiring postoperative mechanical ventilation and stroke care. Despite use of a remote video interpreter, our language-discordant nursing and physician providers faced challenges in managing agitation and delirium and assessing neurological function. This case highlights the need for adequate interpretation equipment, linguistic diversity among providers, and interventions to promote and enable consistent certified and professional medical interpreter use.
Collapse
Affiliation(s)
- Jason S Chwa
- From the Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Joseph Szokol
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anahat K Dhillon
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Betty M Luan-Erfe
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
18
|
Silva-Rudberg JA, Carrión CI, Pérez-Palmer N, Li J, Mehta SK, Diab NS, Mecca AP, O'Dell RS. Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers. Am J Geriatr Psychiatry 2024; 32:773-786. [PMID: 38336573 PMCID: PMC11162952 DOI: 10.1016/j.jagp.2024.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Previous studies have examined disparities in dementia care that affect the U.S. Hispanic/Latino population, including clinician bias, lack of cultural responsiveness, and less access to health care. However, there is limited research that specifically investigates the impact of language barriers to health disparities in dementia diagnosis. METHODS In this retrospective cross-sectional study, 12,080 English- or Spanish- speaking patients who received an initial diagnosis of mild cognitive impairment (MCI) or dementia between July 2017 and June 2019 were identified in the Yale New Haven Health (YNHH) electronic medical record. To evaluate the timeliness of diagnosis, an initial diagnosis of MCI was classified as "timely", while an initial diagnosis of dementia was considered "delayed." Comprehensiveness of diagnosis was assessed by measuring the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis. Binomial logistic regressions were calculated with and without adjustment for age, legal sex, ethnicity, neighborhood disadvantage, and medical comorbidities. RESULTS Spanish speakers were less likely to receive a timely diagnosis when compared with English speakers both before (unadjusted OR, 0.65; 95% CI, 0.53-0.80, p <0.0001) and after adjusting for covariates (adjusted OR, 0.55; 95% CI, 0.40-0.75, p = 0.0001). Diagnostic services were provided equally between groups, except for referrals to geriatrics, which were more frequent among Spanish-speaking patients. A subgroup analysis revealed that Spanish-speaking Hispanic/Latino patients were less likely to receive a timely diagnosis compared to English-speaking Hispanic/Latino patients (adjusted OR, 0.53; 95% CI, 0.38-0.73, p = 0.0001). CONCLUSIONS Non-English language preference is likely to be a contributing factor to timely diagnosis of cognitive impairment. In this study, Spanish language preference rather than Hispanic/Latino ethnicity was a significant predictor of a less timely diagnosis of cognitive impairment. Policy changes are needed to reduce barriers in cognitive disorders care for Spanish-speaking patients.
Collapse
Affiliation(s)
- Jason A Silva-Rudberg
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Medicine (JAS-R,), University of California, San Francisco, San Francisco, CA
| | - Carmen I Carrión
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Neurology (CIC), Yale University School of Medicine, New Haven, CT
| | - Nicolás Pérez-Palmer
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (NP-P), Veteran's Affairs Connecticut Healthcare System, West Haven, CT
| | - Judy Li
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Sumarth K Mehta
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Nicholas S Diab
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Adam P Mecca
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Ryan S O'Dell
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT.
| |
Collapse
|
19
|
Layrisse-Landaeta V, Dincheva GR, Khedr S, Geng A, Schombs M, Maisha K, Chao SY, Chen CC. Impact of English proficiency on use of Glasgow Coma Scale in geriatric patients with traumatic brain injury. Trauma Surg Acute Care Open 2024; 9:e001439. [PMID: 38957620 PMCID: PMC11217998 DOI: 10.1136/tsaco-2024-001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
Background The relationship between English proficiency (EP), Glasgow Coma Scale (GCS) and traumatic brain injury (TBI) is not well characterized. We aimed to understand the impact of limited English proficiency (LEP) on the evaluation and outcomes of TBI. Methods Retrospective comparative study in a single institution of patients aged ⪰65 who presented to the emergency department after a fall with head strike between January 2018 and December 2021. TBI was defined as documented loss of consciousness or intracranial hemorrhage (ICH). Relationships between EP, GCS, and TBI were analyzed with multivariable and propensity score-matched models. Results Of the 2905 included, 1233 (42%) had LEP. Most LEP patients were Asian (60%) while the majority of EP patients were non-Hispanic Caucasians (72%). In a univariate analysis, LEP had higher incidence of decreased GCS and was strongly correlated with risk of TBI (OR 1.47, CI 1.26 to 1.71). After adjusting for multiple covariates including race, LEP did not have a significantly increased risk for GCS score <13 (OR 1.66, CI 0.99 to 2.76) or increased risk of TBI. In the matched analysis, LEP had a small but significantly higher risk of GCS score <13 (OR 1.03, CI 1.02 to 1.05) without an increased risk in TBI. Decreased GCS remained strongly correlated with presence of ICH in LEP patients in the adjusted model (OR 1.39, CI 1.30 to 1.50). Conclusions LEP correlated with lower GCS in geriatric patients with TBI. This association weakened after adjusting for factors like race, suggesting racial disparities may have more influence than language differences. Moreover, GCS remained effective for predicting ICH in LEP individuals, highlighting its value with suitable translation resources. Level of evidence This is a Level III evidence restrospective comparative study.
Collapse
Affiliation(s)
| | | | - Shahenda Khedr
- General Surgery, NewYork-Presbyterian Queens, Queens, New York, USA
| | - Andrew Geng
- General Surgery, NewYork-Presbyterian Queens, Queens, New York, USA
| | - Michele Schombs
- General Surgery, NewYork-Presbyterian Queens, Queens, New York, USA
| | - Kazi Maisha
- General Surgery, NewYork-Presbyterian Queens, Queens, New York, USA
| | - Steven Y Chao
- General Surgery, NewYork-Presbyterian Queens, Queens, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Chun-Cheng Chen
- General Surgery, TriStar Skyline Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
20
|
Curatola N, Prasad P, Bell BK, Fang MC, Rambachan A. Assessing for differences in opioid administration during inpatient end-of-life care for patients with limited English proficiency. J Hosp Med 2024; 19:596-604. [PMID: 38544317 PMCID: PMC11222029 DOI: 10.1002/jhm.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) may have worse health outcomes and differences in processes of care. Language status may particularly affect situations that depend on communication, such as symptom management or end-of-life (EOL) care. OBJECTIVE The objective of this study was to assess whether opioid prescribing and administration differs by English proficiency (EP) status among hospitalized patients receiving EOL care. METHODS This single-center retrospective study identified all adult patients receiving "comfort care" on the general medicine service from January 2013 to September 2021. We assessed for differences in the quantity of opioids administered (measured by oral morphine equivalents [OME]) by patient LEP status using multivariable linear regression, controlling for other patient and medical factors. RESULTS We identified 2652 patients receiving comfort care at our institution during the time period, of whom 1813 (68%) died during the hospitalization. There were no significant differences by LEP status in terms of mean OME per day (LEP received 30.8 fewer OME compared to EP, p = .91) or in the final 24 h before discharge (LEP received 61.7 more OME compared to EP, p = .80). CONCLUSION LEP was not associated with differences in the amount of opioids received for patients whose EOL management involved standardized order sets for symptom management at our hospital.
Collapse
Affiliation(s)
- Nicole Curatola
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Priya Prasad
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brieze K. Bell
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Margaret C. Fang
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Aksharananda Rambachan
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
21
|
Nouri S, Pantilat SZ, Meier DE, Nicolla JM, Friedman FAP, Chan RY, Candrian C. REaL and SOGI Data Collection: Results from a Palliative Care Quality Collaborative Survey. J Pain Symptom Manage 2024; 68:e82-e85. [PMID: 38670296 DOI: 10.1016/j.jpainsymman.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine(S.N., S.Z.P.), University of California San Francisco, San Francisco, California, USA.
| | - Steven Z Pantilat
- Division of Palliative Medicine(S.N., S.Z.P.), University of California San Francisco, San Francisco, California, USA
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine(D.E.M.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan M Nicolla
- Palliative Care Quality Collaborative(J.M.N., F.A.P.F., R.Y.C.), Chicago, Illinois, USA
| | - Fred A P Friedman
- Palliative Care Quality Collaborative(J.M.N., F.A.P.F., R.Y.C.), Chicago, Illinois, USA
| | - Robin Y Chan
- Palliative Care Quality Collaborative(J.M.N., F.A.P.F., R.Y.C.), Chicago, Illinois, USA
| | - Carey Candrian
- Division of General Internal Medicine(C.C.), University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
22
|
Quadri NS, Martins SL, Sidebottom A, Mohamed S, Ha N, Nguyen D, Patel L, Kethireddy R. Association of Language Preference with Therapeutic Care for Hospitalized COVID-19 Patients. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02065-2. [PMID: 38951369 DOI: 10.1007/s40615-024-02065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/31/2024] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION There is a paucity of research investigating disparities in utilization of inpatient therapeutics for COVID-19 by language preference. The primary aim of this study was to assess if the likelihood of treatment with novel COVID-19 therapies differed for patients using a language other than English (LOE) relative to English-speaking patients. METHODS This was a retrospective observational cohort study of COVID-19 patients hospitalized between March 1, 2020, and June 30, 2022, across 11 hospitals within a single not-for-profit health system. Multivariable relative risks were estimated for the impact of preferred language on the receipt of novel COVID-19 therapies: baricitinib, remdesivir, tocilizumab, and convalescent plasma. RESULTS This study included 12,510 hospitalized adults with English as the most common preferred language (92.3%) followed by Spanish (3.1%), Somali (1.3%), Russian (0.9%), and Hmong (0.6%). Spanish speakers were more likely to receive any of the novel COVID-19 therapies compared to English speakers (RR 1.45; CI 1.32-1.59). Estimates for Hmong, Somali, Russian, and Other language groups were not statistically significant and closer to the null (aRR range, 0.89-1.12). CONCLUSION Linguistic patterns in health outcomes expose inherent heterogeneity within racial and ethnic groups. Our study found that Spanish speakers were nearly 1.5 times more likely to receive any of the four novel inpatient COVID-19 therapeutics in comparison to English speakers. Future research is needed to explore the reasons for the heterogeneous findings including temporal influence, cultural factors, informed consent comprehension, and therapeutic hesitancy in all groups.
Collapse
Affiliation(s)
- Nasreen S Quadri
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, 800 East 28thSt, Mail Route 11135, Minneapolis, MN, 55407, USA.
- Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, USA.
- National Resource Center for Refugees, Immigrants, Migrants, Minneapolis, MN, USA.
| | | | | | - Samira Mohamed
- Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, USA
- National Resource Center for Refugees, Immigrants, Migrants, Minneapolis, MN, USA
| | - Ngoc Ha
- Care Delivery Research, Allina Health, Minneapolis, MN, USA
| | - Duc Nguyen
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, 800 East 28thSt, Mail Route 11135, Minneapolis, MN, 55407, USA
| | - Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, 800 East 28thSt, Mail Route 11135, Minneapolis, MN, 55407, USA
| | - Rajesh Kethireddy
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, 800 East 28thSt, Mail Route 11135, Minneapolis, MN, 55407, USA
| |
Collapse
|
23
|
Venkataraman D, Rao D. Recognizing and navigating barriers to hope in gastrointestinal cancer patients. J Gastrointest Oncol 2024; 15:1355-1357. [PMID: 38989430 PMCID: PMC11231856 DOI: 10.21037/jgo-24-353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/31/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
| | - Devika Rao
- Division of Solid Tumor Gastrointestinal Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
24
|
Reppas-Rindlisbacher C, Rawal S. Understanding linguistic inequities in healthcare: moving from the technical to the social. BMJ Qual Saf 2024; 33:416-418. [PMID: 38609172 DOI: 10.1136/bmjqs-2023-016873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Christina Reppas-Rindlisbacher
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Shail Rawal
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Molina RL, Kaimal AJ. Heard but Excluded: A Language Manifesto. JAMA 2024; 331:1987-1988. [PMID: 38780926 DOI: 10.1001/jama.2024.6186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
This Viewpoint discusses dismantling language barriers via multipronged approaches grounded in innovation, human-centered design, and systems thinking in 3 key areas.
Collapse
Affiliation(s)
- Rose L Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Anjali J Kaimal
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa
| |
Collapse
|
26
|
Bacon E, Thiessen ME, Vogel J, Whitfield J, Cervantes L, Podewils LJ. The Role of Language in Hospital Admissions: The COVID-19 Experience in a Safety-Net Hospital Emergency Department. J Emerg Med 2024:S0736-4679(24)00193-8. [PMID: 39271404 DOI: 10.1016/j.jemermed.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Emergency departments (EDs) are often patients' first point of contact with the health care system. Race, ethnicity, and language all influence factors leading up to ED visits and patient experiences within the ED. There is limited evidence showing how race, ethnicity, and language interact to shape ED experiences, particularly during the COVID-19 pandemic when EDs were extremely strained. OBJECTIVES Using a retrospective review, we evaluated the association of race, ethnicity and preferred language on hospital admissions from the ED for patients with COVID-19 in an urban, safety-net hospital during the first year of the COVID-19 pandemic before vaccines were widely available. METHODS We performed a nested regression analysis using generalized estimating equation (GEE) logit models to estimate the impact of language, race, and ethnicity on hospital admissions while controlling for other health conditions and healthcare utilization. RESULTS Patients who spoke Spanish and were Latino had 72% higher odds [95% confidence interval (CI):1.34-2.2] of hospital admission compared to patients who were White and spoke English. Patients who were Asian, the majority of whom also spoke languages other than English, had 130% higher odds (95% CI: 1.39-3.92) of hospital admission compared to patients who were White and English Speaking. CONCLUSIONS Findings suggest multiple mechanisms influence hospital admissions for patients who are racially and ethnically minoritized and speak Spanish. Providers may have admitted patients as a precaution rather than because of more advanced illness. Evaluating race, ethnicity, and language concurrently can reveal how intersectional factors shape patient experiences in the ED.
Collapse
Affiliation(s)
- Emily Bacon
- Denver Health and Hospital Authority, Denver, Colorado.
| | - Molly E Thiessen
- Denver Health and Hospital Authority, Denver, Colorado; Department of Medicine, University of Colorado, Aurora, Colorado
| | - Jody Vogel
- Stanford University, Palo Alto, California
| | - Jennifer Whitfield
- Denver Health and Hospital Authority, Denver, Colorado; Department of Medicine, University of Colorado, Aurora, Colorado
| | - Lilia Cervantes
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Laura Jean Podewils
- Denver Health and Hospital Authority, Denver, Colorado; Colorado School of Public Health, University of Colorado, Aurora, Colorado
| |
Collapse
|
27
|
Lauwers EDL, Vandecasteele R, McMahon M, De Maesschalck S, Willems S. The patient perspective on diversity-sensitive care: a systematic review. Int J Equity Health 2024; 23:117. [PMID: 38840119 PMCID: PMC11155005 DOI: 10.1186/s12939-024-02189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The provision of diversity-sensitive care is a promising approach towards reducing health disparities. Recent criticism and a scientific gap demonstrate the need for the patient perspective on diversity-sensitive care. This systematic review aims to describe the patient perspective, including patient experiences, expectations, and satisfaction with diversity-sensitive care provided by healthcare providers. METHODS In December 2022 the Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO and additionally Google Scholar were searched for original studies that described or measured patient expectations, experiences, and/or satisfaction, specifically focusing on cultural or diversity competence of healthcare providers. Analysis of the collected data was performed using a convergent mixed-methods design based on thematic synthesis. RESULTS From initially 5,387 articles, 117 were selected for full-text screening, and ultimately, 34 articles were included in this study. The concept of diversity-sensitive care was observed to comprise three components. The first component is focused on patient-centered care and includes competencies such as clear and direct communication, shared decision-making, individualized care, empathy, and consideration. The second component centers on providing culturally tailored information, adjusting care to cultural needs, working with interpreters, allyship, community partnerships, self-awareness, and cultural knowledge, and builds upon the first component. Across the first two components of diversity-sensitive care, patients have reported experiencing dissatisfaction and encountering shortcomings in their healthcare providers, sometimes resulting in the third and final component pertaining to provider care. This component underscores the importance of linguistic, ethnic, cultural, and gender concordance in delivering quality care. CONCLUSION In conclusion, the patient perspective on diversity-sensitive care encompasses multiple components, from patient-centered care to concordant care. The components incorporate various competencies as communication skills, empathy, self-awareness and adjusting care to cultural needs. Patients reported experiencing dissatisfaction and shortcomings across all components of diversity-sensitive care provided by healthcare providers.
Collapse
Affiliation(s)
- Ewout Daniël Lieven Lauwers
- Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, South Holland, 3015 GD, The Netherlands.
| | - Robin Vandecasteele
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Michael McMahon
- Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Stéphanie De Maesschalck
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Sara Willems
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
| |
Collapse
|
28
|
Lee JK, Koripella PC, Jensen CD, Merchant SA, Fox JM, Chang SX, Dang CH, Velayos FS, Boparai ES, Evans NS, Leung LJ, Badalov JM, Quesenberry CP, Corley DA, Levin TR. Randomized Trial of Patient Outreach Approaches to De-implement Outdated Colonoscopy Surveillance Intervals. Clin Gastroenterol Hepatol 2024; 22:1315-1322.e7. [PMID: 38191014 DOI: 10.1016/j.cgh.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIMS Guidelines now recommend patients with low-risk adenomas receive colonoscopy surveillance in 7-10 years and those with the previously recommended 5-year interval be re-evaluated. We tested 3 outreach approaches for transitioning patients to the 10-year interval recommendation. METHODS This was a 3-arm pragmatic randomized trial comparing telephone, secure messaging, and mailed letter outreach. The setting was Kaiser Permanente Northern California, a large integrated healthcare system. Participants were patients 54-70 years of age with 1-2 small (<10 mm) tubular adenomas at baseline colonoscopy, due for 5-year surveillance in 2022, without high-risk conditions, and with access to all 3 outreach modalities. Patients were randomly assigned to the outreach arm (telephone [n = 200], secure message [n = 203], and mailed letter [n = 201]) stratified by age, sex, and race/ethnicity. Outreach in each arm was performed by trained medical assistants (unblinded) communicating in English with 1 reminder attempt at 2-4 weeks. Participants could change their assigned interval to 10 years or continue their planned 5-year interval. RESULTS Sixty-day response rates were higher for telephone (64.5%) and secure messaging outreach (51.7%) vs mailed letter (31.3%). Also, more patients adopted the 10-year surveillance interval in the telephone (37.0%) and secure messaging arms (32.0%) compared with mailed letter (18.9%) and rate differences were significant for telephone (18.1%; 97.5% confidence interval: 8.3%-27.9%) and secure message outreach (13.1%; 97.5% confidence interval: 3.5%-22.7%) vs mailed letter outreach. CONCLUSIONS Telephone and secure messaging were more effective than mailed letter outreach for de-implementing outdated colonoscopy surveillance recommendations among individuals with a history of low-risk adenomas in an integrated healthcare setting. (ClinicalTrials.gov, Number: NCT05389397).
Collapse
Affiliation(s)
- Jeffrey K Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
| | - Pradeep C Koripella
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Christopher D Jensen
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sophie A Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jeffrey M Fox
- Department of Gastroenterology, Kaiser Permanente San Rafael Medical Center, San Rafael, California
| | - Suyi X Chang
- Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California
| | - Christian H Dang
- Department of Gastroenterology, Kaiser Permanente San Leandro Medical Center, San Leandro, California
| | - Fernando S Velayos
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Eshandeep S Boparai
- Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California
| | - Nicole S Evans
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Lawrence J Leung
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Jessica M Badalov
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Theodore R Levin
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California
| |
Collapse
|
29
|
Palme C, Hafner FS, Hafner L, Peifer TP, Huber AL, Steger B. Artificial Intelligence (AI) Reveals Ethnic Disparities in Cataract Detection and Treatment. Ophthalmol Ther 2024; 13:1683-1692. [PMID: 38642283 PMCID: PMC11109066 DOI: 10.1007/s40123-024-00945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The aim of this work is to identify patients at risk of limited access to healthcare through artificial intelligence using a name-ethnicity classifier (NEC) analyzing the clinical stage of cataract at diagnosis and preoperative visual acuity. METHODS This retrospective, cross-sectional study includes patients seen in the cataract clinic of a tertiary care hospital between September 2017 and February 2020 with subsequent cataract surgery in at least one eye. We analyzed 4971 patients and 8542 eyes undergoing surgery. RESULTS The NEC identified 360 patients with names classified as 'non-German' compared to 4611 classified as 'German'. Advanced cataract (7 vs. 5%; p = 0.025) was significantly associated with group 'non-German'. Mean best-corrected visual acuity in group 'non-German' was 0.464 ± 0.406 (LogMAR), and in group 'German' was 0.420 ± 0.334 (p = 0.009). This difference remained significant after exclusion of patients with non-lenticular ocular comorbidities. Surgical time and intraoperative complications did not differ between the groups. Retrobulbar or general anesthesia was chosen significantly more frequently over topical anesthesia in group 'non-German' compared to group 'German' (24 vs. 18% respectively; p < 0.001). CONCLUSIONS This study shows that artificial intelligence is able to uncover health disparities between people with German compared to non-German names using NECs. Patients with non-German names, possibly facing various social barriers to healthcare access such as language barriers, have more advanced cataracts and worse visual acuity upon presentation. Artificial intelligence may prove useful for healthcare providers to discover and counteract such inequalities and establish tailored preventive measures to decrease morbidity in vulnerable population subgroups.
Collapse
Affiliation(s)
- Christoph Palme
- Department of Ophthalmology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Lena Hafner
- Department of Politics and International Studies, University of Cambridge, Cambridge, UK
| | | | - Anna Lena Huber
- Department of Ophthalmology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Bernhard Steger
- Department of Ophthalmology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| |
Collapse
|
30
|
Lim K, Quintero Silva L, Raj M. Family Caregivers' Role in Navigating Diet: Perspectives from Caregivers of Older Asian Americans. J Appl Gerontol 2024; 43:775-785. [PMID: 37991403 DOI: 10.1177/07334648231214908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Family caregivers uphold significant healthcare responsibilities including language translation and diet management. This study sought to understand family caregivers' experiences and challenges navigating and managing their older Asian American relative's diet. We conducted an exploratory sequential mixed-methods study with family caregivers involving (1) qualitative interviews (n = 40) and (2) a nationwide survey (n = 100). Interviewees discussed their role and challenges with (a) applying American/Western clinical dietary recommendations to their relative's traditional meal preferences and (b) managing misalignment between their relative's traditional dietary preferences and the food offered in hospitals and long-term care environments. Survey responses triangulated; almost 65% of family caregivers prepared and brought traditional meals to healthcare facilities upon observing a lack of culturally relevant food options. Culturally relevant nutrition training for family caregivers can help them support their relative in community settings. Creating an inclusive healthcare system requires transforming the food environment within healthcare facilities.
Collapse
Affiliation(s)
| | | | - Minakshi Raj
- University of Illinois Urbana Champaign, Champaign, IL, USA
| |
Collapse
|
31
|
Dey K, Romero Arocha S, Park YS, Ortega P. Prevalence and quality of medical Spanish education in US osteopathic medical schools: a national survey. J Osteopath Med 2024; 124:249-255. [PMID: 38416808 DOI: 10.1515/jom-2023-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/03/2024] [Indexed: 03/01/2024]
Abstract
CONTEXT Spanish is the language in the United States with the greatest language-concordant physician deficit. Allopathic medical Spanish programs have proliferated, but the national prevalence of medical Spanish education at osteopathic medical schools has never been evaluated. OBJECTIVES The objectives of this study are to describe the medical Spanish educational landscape at US osteopathic schools and evaluate program adherence to previously established basic standards. METHODS Between March and October 2022, surveys were sent to all 44 member schools of the American Association of Colleges of Osteopathic Medicine (AACOM). For nonrespondents, data were obtained from publicly available websites. Primary surveys were sent to deans or diversity, equity, and inclusion officers at each osteopathic school to determine whether medical Spanish was offered and to identify a medical Spanish leader. Medical Spanish leaders received the secondary survey. The main measures of this study were the prevalence of medical Spanish programs at osteopathic schools and the extent to which existing programs met each of the four basic standards: having a faculty educator, providing a curricular structure, assessing learner skills, and awarding institutional course credit. RESULTS We gathered medical Spanish information from 90.9 % (40/44) of osteopathic schools. Overall, 88.6 % (39/44) offered medical Spanish, of which 66.7 % (26/39) had formal curricula, 43.6 % (17/39) had faculty educators, 17.9 % (7/39) assessed learner skills, and 28.2 % (11/39) provided course credit. Only 12.8 % (5/39) of osteopathic schools with medical Spanish programs met all basic standards. Urban/suburban schools were likelier to offer medical Spanish than rural schools (p=0.020). Osteopathic schools in states with the highest Spanish-speaking populations were more likely to offer student-run initiatives (p=0.027). CONCLUSIONS Most osteopathic schools provide medical Spanish education, but work is needed to improve consistency, quality, and sustainability. Future research should focus on osteopathic student language proficiency assessment, improve medical Spanish accessibility for students at rural programs, and explore the unique content areas of osteopathic medical Spanish education.
Collapse
Affiliation(s)
- Kally Dey
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, IL, USA
| | | | - Yoon Soo Park
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL, USA
| | - Pilar Ortega
- Departments of Medical Education and Emergency Medicine, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Diversity, Equity, and Inclusion, Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| |
Collapse
|
32
|
Fortney CA, Garcia D, Gerhardt CA, Baughcum AE, Slaughter JL, Rodriguez EM. Pilot Testing Transcreated Spanish-Language Study Materials for Symptom Research With Infants and Parents in the Neonatal Intensive Care Unit. Adv Neonatal Care 2024; 24:243-252. [PMID: 38729653 PMCID: PMC11141341 DOI: 10.1097/anc.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Rising admission rates of Hispanic/Latinx families to the neonatal intensive care unit (NICU) have increased the number of non-English-speaking individuals who may wish to participate in research studies. However, a lack of appropriately translated research study materials may limit the opportunity for these families to be involved in research that could impact the care that infants and families receive in the NICU. PURPOSE The primary purpose was to pilot test study materials that were transcreated from English to Spanish with the assistance of a bilingual community advisory board with Spanish-speaking parents of NICU infants. METHODS A total of 19 Spanish-speaking parents (15 mothers and 4 fathers) who were representative of the population of interest completed paper-and-pencil surveys, along with a cognitive interview. Preliminary data related to decision-making and goals of care, infant symptoms, and their experiences in the NICU were also collected. RESULTS The internal reliability of the transcreated study instruments ranged from good to excellent (α= 0.82-0.99). Participants reported that study materials were not offensive and did not make them feel uncomfortable; however, they found some words/phrases to be confusing. Parents had the opportunity to provide suggested wording changes. IMPLICATIONS FOR PRACTICE AND RESEARCH Language barriers and a lack of cultural responsiveness can affect the care that infants and their families receive. More accurate and culturally appropriate transcreation of study materials can remove barriers to research participation and facilitate better communication with non-English-speaking families, which may lead to the development of better-informed evidence-based interventions and clinical practices in the NICU.
Collapse
Affiliation(s)
- Christine A Fortney
- Martha S. Pitzer Center for Women, Children & Youth (Dr Fortney), The Ohio State University College of Nursing, Columbus, Ohio; Center for Biobehavioral Health (Dr Fortney, Ms Garcia, and Dr Gerhardt), Center for Perinatal Research (Dr Slaughter), Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics (Dr Gerhardt, Dr Baughcum, and Dr Slaughter), The Ohio State University College of Medicine, Columbus, Ohio; Department of Psychology (Dr Gerhardt), The Ohio State University, Columbus, Ohio; Departments of Psychology and Neuropsychology (Dr Baughcum), Division of Neonatology (Dr Slaughter), Nationwide Children's Hospital, Columbus, Ohio; and Department of Educational Psychology (Dr Rodriguez), College of Education, University of Texas at Austin, Austin, Texas
| | | | | | | | | | | |
Collapse
|
33
|
Poljo A, Tynes DM, Timper K, Süsstrunk J, Kraljević M, Peterli R, Billeter AT, Müller-Stich BP, Klasen JM. Breaking down barriers to bariatric care: a qualitative study on how telemedicine could transform patient experiences in a Swiss monocentric setting. BMJ Open 2024; 14:e083142. [PMID: 38772586 PMCID: PMC11110597 DOI: 10.1136/bmjopen-2023-083142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/30/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE Telemedicine is becoming an increasingly feasible option for patients with chronic diseases due to its convenience, cost-effectiveness and ease of access. While there are certain limitations, the benefits can be appreciated by those seeking repetitive care. The perception of telemedicine as an alternative to recurrent, in-person appointments for patients with obesity in structured bariatric programmes is still unclear. This content analysis' primary endpoint was to explore how patients within our bariatric programme perceived telemedicine and virtual consultations as a new way of communication during COVID-19. DESIGN A qualitative study using semistructured interviews and qualitative content analysis method by Elo and Kyngäs following four steps: data familiarisation, coding and categorising with Quirkos software and final interpretation guided by developed categories. SETTING University Hospital, Switzerland. PARTICIPANTS We conducted 33 interviews with 19 patients from a structured bariatric programme. RESULTS Most patients shared positive experiences, acknowledging the convenience and accessibility of virtual appointments. Others voiced concerns, especially regarding telemedicine's limitations. These reservations centred around the lack of physical examinations, difficulties in fostering connections with healthcare providers, as well as barriers stemming from language and technology. The research identified a spectrum of patient preferences in relation to telemedicine versus in-person visits, shaped by the immediacy of their concerns and their availability. CONCLUSION While telemedicine is increasingly accepted by the public and provides accessible and cost-effective options for routine follow-up appointments, there are still obstacles to overcome, such as a lack of physical examination and technological limitations. However, integrating virtual alternatives, like phone or video consultations, into routine bariatric follow-ups could improve continuity and revolutionise bariatric care.
Collapse
Affiliation(s)
- Adisa Poljo
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Claraspital and University Hospital Basel, Basel, Switzerland
| | - Deborah M Tynes
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Katharina Timper
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Julian Süsstrunk
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Claraspital and University Hospital Basel, Basel, Switzerland
| | - Marko Kraljević
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Claraspital and University Hospital Basel, Basel, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Claraspital and University Hospital Basel, Basel, Switzerland
| | - Adrian T Billeter
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Claraspital and University Hospital Basel, Basel, Switzerland
| | - Beat P Müller-Stich
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Claraspital and University Hospital Basel, Basel, Switzerland
| | - Jennifer M Klasen
- Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Claraspital and University Hospital Basel, Basel, Switzerland
| |
Collapse
|
34
|
Arya AN, Hyman I, Holland T, Beukeboom C, Tong CE, Talavlikar R, Eagan G. Medical Interpreting Services for Refugees in Canada: Current State of Practice and Considerations in Promoting this Essential Human Right for All. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:588. [PMID: 38791802 PMCID: PMC11121150 DOI: 10.3390/ijerph21050588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
Language barriers, specifically among refugees, pose significant challenges to delivering quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development of innovative alternatives such as telephone-based and video-conferencing medical interpreting services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights the absence of a cohesive national strategy, reflected in diverse funding models employed across provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating for medical interpreting, both as a moral imperative and a prudent investment, this article draws from human rights principles and ethical considerations, justified in national and international guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally, this article illuminates decision-making processes for utilizing interpreting services; recognizing the pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating intersectional considerations such as gender, culture and age, underscoring the importance of a collaborative approach. Finally, it provides recommendations at provider, organizational and system levels to ensure equitable access to this right and to promote the health and well-being of refugees and other individuals facing language barriers within Canada's healthcare system.
Collapse
Affiliation(s)
- Akshaya Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, ON L8S 3L8, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
- Kitchener-Waterloo Centre for Family Medicine Refugee Health Clinic, Kitchener, ON N2G 1C5, Canada;
| | - Ilene Hyman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
| | - Tim Holland
- Department of Bioethics, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Newcomer Health Clinic, Halifax, NS B3L 4P1, Canada
| | - Carolyn Beukeboom
- Kitchener-Waterloo Centre for Family Medicine Refugee Health Clinic, Kitchener, ON N2G 1C5, Canada;
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 3K7, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Catherine E. Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Rachel Talavlikar
- Department of Family Medicine, University of Calgary, Calgary, AB T3H 0N9, Canada;
- Mosaic Refugee Health Clinic, Calgary, AB T2A 5H5, Canada
| | - Grace Eagan
- Language Services & Digital Strategy, Access Alliance Multicultural Health & Community Services, Toronto, ON M5T 3A9, Canada;
| |
Collapse
|
35
|
Valle Coto MG, Iñiguez RX, Lentskevich MA, Ally SA, Farfan JF, Park YS, Gangopadhyaya AG, Ortega P. Teaching foundational language equity concepts in the pre-clinical curriculum. BMC MEDICAL EDUCATION 2024; 24:485. [PMID: 38698378 PMCID: PMC11064417 DOI: 10.1186/s12909-024-05474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Despite the prevalence of non-English languages in the US population, existing medical training to teach communication with linguistically diverse communities is limited to electives or solely focuses on medical interpreting. Language-appropriate communication skills are seldom comprehensively integrated in medical education. This study describes the development and evaluation of an intervention to teach foundational language equity concepts. METHODS The authors implemented a pre-clinical language equity course at three medical school campuses between August 2020 and March 2022. Sessions focused on the impact of language in health, physician language proficiency standards, and working with medical interpreters. The study sought to (1) understand students' language skills and prior clinical experiences with patients with non-English language preference and (2) evaluate the curriculum's impact. Students self-reported their language skills and experiences as part of a voluntary pre-questionnaire. Pre and post-questionnaires evaluated knowledge, attitudes, and intent to apply language equity concepts. Descriptive statistics and chi-squared tests were used to examine trends; themes were identified from free-text responses. RESULTS Overall, 301 students completed the course, 252 (83%) completed at least one questionnaire; for each session, between 35% and 46% of learners completed both pre and post-questionnaires. Three quarters (189/252) reported non-English languages. Over half (138/252) reported previous non-English language patient care, and 28% (62/224) had served as ad hoc (untrained) interpreters. Only two students (< 1%) had ever been assessed for medical language abilities. Students demonstrated improved post-course language equity knowledge, strategies for interpreter-mediated encounters, and likelihood to report a plan for language skills assessment (all p < .001). Most plans were multifaceted (61%, 38/62), involving goals like completing a language course, taking a proficiency exam, openly discussing skills and uncertainties with team members, and increasing professional interpreter utilization. CONCLUSIONS A longitudinal language equity curriculum can be feasibly integrated in pre-clinical education, highlight the linguistic diversity of the student body, and serve as a first step in ensuring that all students have a strong language equity foundation prior to clinical rotations. Future steps include evaluating the intervention's potential long-term effects on professional interpreter utilization, student clinical performance, and institutional culture that promotes multilingualism.
Collapse
Affiliation(s)
| | | | - Marina A Lentskevich
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Syeda Akila Ally
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Julia F Farfan
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Ananya G Gangopadhyaya
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Pilar Ortega
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA.
- Department of Diversity, Equity, and Inclusion, Accreditation Council for Graduate Medical Education, Chicago, IL, USA.
| |
Collapse
|
36
|
Mendez M, Panganiban K, Kieran K. Guess Who's Coming to Clinic? Companions in a Pediatric Urology Clinic. J Surg Res 2024; 297:144-148. [PMID: 38531117 DOI: 10.1016/j.jss.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/30/2023] [Accepted: 01/16/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Understanding who accompanies children to clinic visits is necessary to engage stakeholders and tailor communication and educational materials. We undertook this study to describe the clinical companions for new patients in a general pediatric urology clinic. METHODS This retrospective cross-sectional study included all new urology patients aged less than 18 y at a single freestanding quaternary care children's hospital in selected months of 2019 and 2022. Data were collected on patient demographics, diagnosis, level of community disadvantage, and companion present. The number and identities of companions of patients living in more and less disadvantaged neighborhoods were compared. RESULTS Of 1940 patients, 1014 (52%) were accompanied by mothers alone, 266 (14%) by fathers alone, and 580 (30%) by both mother and father. Mothers were at 85% of clinical visits and fathers at 45% of visits. The likelihood of having one versus two parents present was similar in more and less disadvantaged areas (odds ratio [OR] = 1.11, 95% confidence interval: 0.80-1.55, P = 0.53). When one parent was present, the odds of being accompanied by the mother was lower for patients living in Area Deprivation Index 1-2 (less disadvantaged areas; OR = 0.38, 95% confidence interval: 0.23-0.62, P = 0.0001), and for the father to accompany children aged 12 y and more than infants (OR = 2.16, P = 0.0005) if there was only one parent present. CONCLUSIONS Our findings highlight opportunities to engage nonmaternal caregivers in pediatric urologic care, to further explore parental decisions around appointment attendance, and to optimize how clinical information is delivered to caregivers who are and are not present during appointments.
Collapse
Affiliation(s)
- Meridiana Mendez
- Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Kurt Panganiban
- Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, Seattle, Washington; Department of Urology, University of Washington, Seattle, Washington.
| |
Collapse
|
37
|
Villagrán Castro KN, Hernández Rincón EH, García Zárate G, Jaimes Peñuela CL. [Communication with a culturally and linguistically diverse population from Primary Care]. Semergen 2024; 50:102149. [PMID: 38157756 DOI: 10.1016/j.semerg.2023.102149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/27/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
The care of a culturally and linguistically diverse population is a challenge in primary health care due to language barriers and cultural differences. For this reason, good communication and cultural competence of health personnel is key within medical consultation. Thus, during consultations with this group of people, it is the doctor's duty to identify the patient's culture, their perception of the concept of health, in what way and to what extent they want to be informed, and the role they want to assign to the members of their family before the treatment process begins. For this reason, there are interventions that seek to optimize the care provided to these patients and mitigate the cultural barrier, including the use of multimodal digital tools, the use of translators or interpreters, and training of health personnel in communication and intercultural skills.
Collapse
Affiliation(s)
- K N Villagrán Castro
- Médica de Atención Primaria, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - E H Hernández Rincón
- Médico, Máster en Investigación en Atención Primaria, Doctor en Investigación Clínica, Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia.
| | - G García Zárate
- Médica de Atención Primaria, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - C L Jaimes Peñuela
- Médica, especialista en Medicina Familiar y Comunitaria, Máster en Educación Médica, Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| |
Collapse
|
38
|
Vandecasteele R, Schelfhout S, D'hondt F, De Maesschalck S, Derous E, Willems S. Intercultural effectiveness in GPs' communication and clinical assessment: An experimental study. PATIENT EDUCATION AND COUNSELING 2024; 122:108138. [PMID: 38237531 DOI: 10.1016/j.pec.2024.108138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE This study aimed to investigate potential disparities in general practitioners' overall communication and clinical assessments based on patient ethnicity, while examining the influence of intercultural effectiveness. METHODS Employing a 2 × 2 experimental study design, online video recorded consultations with simulated patients were conducted and analyzed using OSCEs. Each GP (N = 100) completed a consultation with both an ethnic majority and an ethnic minority patient. Additionally, a follow-up survey was administered to gather supplementary data. Paired sample t-tests explored ethnic disparities, correlation and regression analyses determined associations with intercultural attitudes, traits and capabilities. RESULTS No statistically significant differences in GPs' communication or clinical assessment were found based on patients' ethnic background. Positive associations were observed between all aspects of intercultural effectiveness and GPs' consultation behavior. Intercultural traits emerged as a strong and robust predictor of clinical assessment of ethnic minority patients. CONCLUSION Intercultural traits, such as ethnocultural empathy, may play a critical role in GPs' clinical assessment skills during intercultural consultations. PRACTICE IMPLICATIONS Findings provide valuable insights into the determinants of intercultural effectiveness in healthcare, fostering promising targets for interventions and training programs aiming to ensure higher-quality and more equitable care delivery.
Collapse
Affiliation(s)
- Robin Vandecasteele
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stijn Schelfhout
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental Psychology, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Fanny D'hondt
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, 9000 Ghent, Belgium
| | - Stéphanie De Maesschalck
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Eva Derous
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Erasmus University Rotterdam, Erasmus School of Social and Behavioural Sciences, Burgemeester Oudlaan 50, 3062 Rotterdam, the Netherlands
| | - Sara Willems
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium
| |
Collapse
|
39
|
Comfort L, Jain M, Wu H, Nathan L. Rate of Primary Cesarean Delivery by Language Preference among Nulliparas. Am J Perinatol 2024; 41:e1241-e1247. [PMID: 36608699 DOI: 10.1055/a-2008-8540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Sociodemographic factors such as race/ethnicity and socioeconomic status affect primary cesarean delivery rates. Language is associated with disparate health care outcomes but has not been well studied in obstetrics. We examined the association between primary unscheduled cesarean delivery rate and preferred patient language. STUDY DESIGN A retrospective cohort study was conducted at an urban medical center between January 2017 and January 2020. Nulliparous women with early or full-term gestation and having no obstetric or medical contraindication to vaginal delivery were included. We used multivariable linear and logistic regressions to evaluate language differences in cesarean delivery odds and indication for cesarean. RESULTS Of the 1,314 eligible women, 76.8% of patients preferred English, 17.8% Spanish, and 5.4% other languages. Overall cesarean delivery rate was 27.6%. Controlling for age, race/ethnicity, body mass index, insurance, gravidity, pregnancy comorbidities, labor induction, and infant birth weight, Spanish- and other language-speaking women had significantly higher odds of undergoing cesarean compared with English-speaking women (adjusted odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.25, 2.46). Relative proportions of indications for cesarean did not differ by language group. Documented interpreter use was an effect modifier on the relationship between language preference and cesarean (OR with interpreter use: 2.89, 95% CI: 1.90, 4.39). CONCLUSION Primary cesarean delivery rates were significantly higher among nulliparous women who prefer languages other than English. This difference may reflect lack of communication, provider bias or discrimination, or other factors, and should be further studied. Interpreter services should be routinely utilized and documented effectively. KEY POINTS · Women who prefer languages other than English had higher odds of cesarean.. · Indication for cesarean did not differ by language.. · Interpreter use did not reduce risk for cesarean..
Collapse
Affiliation(s)
- Lizelle Comfort
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Meaghan Jain
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Haotian Wu
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Lisa Nathan
- Department of Obstetrics, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
40
|
Beiner C, Qureshi MM, Zhao J, Hu B, Jimenez R, Hirsch AE. Depression and Anxiety Among English- and Spanish-Speaking Patients With Breast Cancer Receiving Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 119:185-192. [PMID: 38070714 DOI: 10.1016/j.ijrobp.2023.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE An estimated 30% and 40% of patients with breast cancer experience depression and anxiety, respectively. However, distress experienced by patients with breast cancer receiving radiation therapy may vary among patients and vary at different time points. This study sought to describe the changes in levels of depression and anxiety experienced by English- and Spanish-speaking patients throughout a course of radiation therapy for breast cancer, along with the effect of different variables to better understand potential gaps. METHODS AND MATERIALS Eligibility criteria included English- and Spanish-speaking females, aged 18 or older, undergoing radiation therapy treatment for breast cancer at 2 institutions. Pre- and posttreatment surveys were completed before and after delivery of radiation therapy. Sociodemographic characteristics collected included race, ethnicity, marital status, education level, longest residency location, religion, housing, and food insecurity. The survey ended with the standardized PHQ-4 questionnaire to assess anxiety and depression. Results were analyzed using the analysis of covariance procedure. RESULTS A total of 160 participants completed pre- and posttreatment surveys, with an initial response rate of 100% (169 patients), though 9 were lost to follow-up. Most of the participants were nonwhite (50%), primarily married (42.5%), and had a high school or associate's level education (46.9%). The total baseline distress mean (BDM) was 2.96 and the final distress mean was 2.78. English-speaking patients comprised 82.5% (n = 132) of the sample and had a BDM of 2.91 with an adjusted change mean decrease of 0.45. Spanish-speaking patients comprised 17.5% (n = 28) of the sample, with a baseline distress mean of 3.21 and an adjusted change mean increase of 1.03 (P = .002). Housing (P = .017) and food insecurity (P = .0002) also showed increasing distress with increased insecurity at baseline. CONCLUSIONS Patients who speak Spanish, identify as Hispanic, or are experiencing food and housing insecurity are at an increased risk for depression and anxiety, and could benefit from more support during their course of radiation therapy to minimize distress.
Collapse
Affiliation(s)
- Corina Beiner
- Boston University Chobanian & Avedisian School of Medicine.
| | | | - Jenny Zhao
- Boston University Chobanian & Avedisian School of Medicine
| | - Bonnie Hu
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rachel Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ariel E Hirsch
- Boston University Chobanian & Avedisian School of Medicine; Department of Radiation Oncology, Boston Medical Center
| |
Collapse
|
41
|
Mercado O, Ruan A, Oluwalade B, Devine M, Gibbs K, Carr L. Leveraging Novel Clinical Decision Support to Improve Preferred Language Documentation in a Neonatal Intensive Care Unit. Appl Clin Inform 2024; 15:629-636. [PMID: 38788772 PMCID: PMC11290947 DOI: 10.1055/a-2332-5843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/22/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Recognition of the patient and family's diverse backgrounds and language preference is critical for communicating effectively. In our hospital's electronic health record, a patient or family's identified language for communication is documented in a discrete field known as "preferred language." This field serves as an interdepartmental method to identify patients with a non-English preferred language, creating a bolded banner for non-English speakers easily identifiable by health care professionals. Despite the importance of documenting preferred language to facilitate equitable care, this field is often blank. OBJECTIVES Using the Institute for Healthcare Improvement's Model for Improvement, our team sought to increase preferred language documentation within the neonatal intensive care unit (NICU) from a baseline of 74% in September 2021 to above 90% within 6 months. METHODS A multidisciplinary team was assembled to address preferred language documentation. Our team incorporated guidance regarding preferred language documentation into a novel clinical decision support (CDS) tool aimed at addressing various safety and quality measures within the NICU. Our primary outcome metric was documentation of family's preferred language. Process measures included overall compliance with the CDS tool. A secondary outcome was the assessment of preferred language documentation accuracy. RESULTS The average rate of preferred language documentation increased from a baseline of 74 to 92% within 6 months and is currently sustained at 96%. Moreover, our follow-up assessments found that 100% of a random sample of contacted patients (n = 88) had their language preferences documented correctly. Overall compliance with the CDS tool remained at 85% throughout the project. CONCLUSION Using a quality improvement framework coupled with a CDS initiative, our team was able to successfully and accurately improve preferred language documentation in our NICU. Future projects include strategies for more equitable care for patients with non-English preferences such as improved interpreter usage and discharge instructions in their preferred language.
Collapse
Affiliation(s)
- Osvaldo Mercado
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia Pennsylvania, United States
| | - Alex Ruan
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Bolu Oluwalade
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Matthew Devine
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kathleen Gibbs
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Leah Carr
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia Pennsylvania, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| |
Collapse
|
42
|
Mensah JA, Fei-Zhang DJ, Rossen JL, Rahmani B, Bentrem DJ, Stein JD, French DD. Assessment of Social Vulnerabilities of Care and Prognosis in Adult Ocular Melanomas in the US. Ann Surg Oncol 2024; 31:3302-3313. [PMID: 38418655 PMCID: PMC11003832 DOI: 10.1245/s10434-024-15038-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Prior works have studied the impact of social determinants on various cancers but there is limited analysis on eye-orbit cancers. Current literature tends to focus on socioeconomic status and race, with sparse analysis of interdisciplinary contributions. We examined social determinants as measured by the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), quantifying eye and orbit melanoma disparities across the United States. METHODS A retrospective review of 15,157 patients diagnosed with eye-orbit cancers in the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017 was performed, extracting 6139 ocular melanomas. SVI scores were abstracted and matched to SEER patient data, with scores generated by weighted averages per population density of county's census tracts. Primary outcome was months survived, while secondary outcomes were advanced staging, high grading, and primary surgery receipt. RESULTS With increased total SVI score, indicating more vulnerability, we observed significant decreases of 23.1% in months survival for melanoma histology (p < 0.001) and 19.6-39.7% by primary site. Increasing total SVI showed increased odds of higher grading (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.02-1.43) and decreased odds of surgical intervention (OR 0.94, 95% CI 0.92-0.96). Of the four themes, higher magnitude contributions were observed with socioeconomic status (26.0%) and housing transportation (14.4%), while lesser magnitude contributions were observed with minority language status (13.5%) and household composition (9.0%). CONCLUSIONS Increasing social vulnerability, as measured by the CDC SVI and its subscores, displayed significant detrimental trends in prognostic and treatment factors for adult eye-orbit melanoma. Subscores quantified which social determinants contributed most to disparities. This lays groundwork for providers to target the highest-impact social determinant for non-clinical factors in patient care.
Collapse
Affiliation(s)
- Joshua A Mensah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David J Fei-Zhang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer L Rossen
- Division of Pediatric Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Bahram Rahmani
- Division of Pediatric Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David J Bentrem
- Division of Surgical Oncology and Medical Social Sciences, Department of Surgery, Chicago, IL, USA
| | - Joshua D Stein
- Division of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Dustin D French
- Departments of Ophthalmology and Medical Social Sciences, Feinberg School of Medicine, Chicago, IL, USA
- Health Services Research and Development Service, Veteran Health Administration, Edward Hines Jr. VA Hospital, Hines, IL, USA
| |
Collapse
|
43
|
Williams A, Little SE, Bryant AS, Smith NA. Mode of Delivery and Unplanned Cesarean: Differences in Rates and Indication by Race, Ethnicity, and Sociodemographic Characteristics. Am J Perinatol 2024; 41:834-841. [PMID: 35235955 DOI: 10.1055/a-1785-8843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE We aimed to examine the relationship of sociodemographic variables with racial/ethnic disparities in unplanned cesarean births in a large academic hospital system. Secondarily, we investigated the relationship of these variables with differences in cesarean delivery indication, cesarean delivery timing, length of second stage and operative delivery. STUDY DESIGN We conducted a retrospective cohort study of births >34 weeks between 2017 and 2019. Our primary outcome was unplanned cesarean delivery after a trial of labor. Multiple gestations, vaginal birth after cesarean, elective repeat or primary cesarean delivery, and contraindications for vaginal delivery were excluded. Associations between mode of delivery and patient characteristics were assessed using Chi-square, Fisher exact tests, or t-tests. Odds ratios were estimated by multivariate logistic regression. Goodness of fit was assessed with Hosmer Lemeshow test. RESULTS Among 18,946 deliveries, the rate of cesarean delivery was 14.8% overall and 21.3% in nulliparous patients. After adjustment for age, body mass index (BMI), and parity, women of Black and Asian races had significantly increased odds of unplanned cesarean delivery; 1.69 (95% CI: 1.45,1.96) and 1.23 (1.08, 1.40), respectively. Single Hispanic women had adjusted odds of 1.65 (1.08, 2.54). Single women had increased adjusted odds of cesarean delivery of 1.18, (1.05, 1.31). Fetal intolerance was the indication for 39% (613) of cesarean deliveries among White women as compared to 63% (231) of Black women and 49% (71) of Hispanic women (p <0.001). CONCLUSION Rates of unplanned cesarean delivery were significantly higher in Black and Asian compared to White women, even after adjustment for age, BMI, parity, and zip code income strata, and rates of unplanned cesarean delivery were higher for Hispanic women self-identifying as single. Racial and ethnic differences were seen in cesarean delivery indications and operative vaginal deliveries. Future work is urgently needed to better understand differences in provider care or patient attributes, and potential provider bias, that may contribute to these findings. KEY POINTS · Racial, ethnic, and socioeconomic differences exist in the odds of unplanned cesarean.. · Indications for unplanned cesarean delivery differed significantly among racial and ethnic groups.. · There may be unmeasured provider level factors which contribute to disparities in cesarean rates..
Collapse
Affiliation(s)
- Alexandria Williams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General, Boston, Massachusetts
| | - Sarah E Little
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison S Bryant
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General, Boston, Massachusetts
| | - Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
44
|
Yang S, Barwise A, Perrucci A, Bartz D. Equitable abortion care for patients with non-English language preference. Contraception 2024; 133:110389. [PMID: 38354764 DOI: 10.1016/j.contraception.2024.110389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Sherry Yang
- Harvard Medical School, Boston, MA, United States; Harvard Kennedy School of Government, Cambridge, MA, United States
| | - Amelia Barwise
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States
| | - Alissa Perrucci
- Women's Options Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States
| | - Deborah Bartz
- Harvard Medical School, Boston, MA, United States; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States.
| |
Collapse
|
45
|
Ortega P, Gregorich SE, Karliner L, González J, Pérez-Cordón C, Iñiguez RX, Izquierdo K, Diamond LC. Validity Evidence for the Physician Oral Language Observation Matrix as a Measure of Medical Spanish Proficiency. J Gen Intern Med 2024; 39:1088-1094. [PMID: 37670071 PMCID: PMC11116337 DOI: 10.1007/s11606-023-08391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The lack of a standardized language assessment process for medical students and physicians communicating in a non-English language threatens healthcare quality and safety. OBJECTIVE To evaluate the validity of a new rating tool, the Physician Oral Language Observation Matrix (POLOM)™, in assessing medical students' oral communication with Spanish-speaking standardized patients (SPs). DESIGN POLOM scores were compared to measures of student medical Spanish proficiency to examine convergent validity and to measures of clinical performance to examine concurrent/criterion validity. PARTICIPANTS Forty-two students at two schools completed SP encounters between January 2021 and April 2022, and POLOM raters scored the videorecorded performances between January and June 2022. MAIN MEASURES Two approaches to generating POLOM total scores were investigated: rater average and strict consensus. Convergent validity was examined via the POLOM's correlations with (1) the phone-based Clinician Cultural and Linguistic Assessment (CCLA) and (2) the self-rated Interagency Language Roundtable scale for healthcare (ILR-H). Concurrent/criterion validity was examined via correlations with (1) the Comunicación y Habilidades Interpersonales (CAI) scale, (2) a checklist completed by the SP, and (3) a faculty rating of the student's post-encounter clinical note. Pearson's correlations of r ≥ 0.5 and r ≥ 0.2 were considered evidence of convergent validity and concurrent/criterion validity, respectively. KEY RESULTS Both rater average and strict consensus POLOM scores were strongly correlated with ILR-H (r = 0.72) and CCLA (r ≥ 0.60), providing evidence of convergent validity. The POLOM was substantially correlated with the CAI (r ≥ 0.29), the SP Checklist (r = 0.32), and the faculty scoring of the student's clinical note (r ≥ 0.24), providing concurrent/criterion validity evidence. CONCLUSIONS The POLOM has demonstrated evidence of convergent and concurrent/criterion validity as a measure of medical students' Spanish proficiency during SP encounters. Additional research is needed to evaluate how the POLOM can be implemented with resident and practicing physicians, applied to other health professions, and adapted to other languages.
Collapse
Affiliation(s)
- Pilar Ortega
- Departments of Medical Education and Emergency Medicine, University of Illinois College of Medicine, Chicago, IL, USA.
- Diversity, Equity, and Inclusion, Accreditation Council for Graduate Medical Education, Chicago, IL, USA.
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leah Karliner
- Division of General Internal Medicine, Center for Aging in Diverse Communities, Multiethnic Health Equity Research Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Javier González
- Language Initiatives Program, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Pérez-Cordón
- Language and Communication Training Unit, United Nations Headquarters, New York, NY, USA
| | - Reniell X Iñiguez
- Internal Medicine, Northwestern University Chicago, Chicago, IL, USA
| | - Karen Izquierdo
- Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Lisa C Diamond
- Hospital Medicine Service, Immigrant Health and Cancer Disparities Service, Departments of Medicine and Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
46
|
Anaya M, Law W, Montoya HL, Moreira CM. Discharge Interventions for Limited English Proficiency Patients: A Scoping Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02003-2. [PMID: 38639867 DOI: 10.1007/s40615-024-02003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Limited English proficiency patients are required under federal law to receive language-concordant care, yet they still receive substandard discharge instructions compared to English-speaking patients. We aimed to summarize the interventions carried out to improve discharge instructions in the limited English proficiency population. METHODS We conducted a scoping review of academic and gray literature from the United States using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols for Scoping Reviews guidelines. We searched PubMed, Embase, and CINAHL for studies to improve discharge communication. RESULTS Of the 3330 studies, 19 studies met the criteria. Core types of interventions included written interventions alone, educational interventions alone, written and educational interventions, audio and visual interventions, and other types of interventions. Even among the same core types of interventions, there were differences in types of interventions, outcomes examined, and results. DISCUSSION The majority of included interventions that studied satisfaction as an outcome measure showed improvement, while the other outcomes were not improved or worsened. More rigorous methodology and community involvement are necessary to further analyze discharge interventions for patients with limited English proficiency (LEP).
Collapse
Affiliation(s)
- Melanie Anaya
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA.
| | - William Law
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| | - Hannah L Montoya
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| | - Carla M Moreira
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| |
Collapse
|
47
|
Garcia Valencia OA, Thongprayoon C, Jadlowiec CC, Mao SA, Leeaphorn N, Budhiraja P, Craici IM, Gonzalez Suarez ML, Cheungpasitporn W. AI-driven translations for kidney transplant equity in Hispanic populations. Sci Rep 2024; 14:8511. [PMID: 38609476 PMCID: PMC11014982 DOI: 10.1038/s41598-024-59237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Health equity and accessing Spanish kidney transplant information continues being a substantial challenge facing the Hispanic community. This study evaluated ChatGPT's capabilities in translating 54 English kidney transplant frequently asked questions (FAQs) into Spanish using two versions of the AI model, GPT-3.5 and GPT-4.0. The FAQs included 19 from Organ Procurement and Transplantation Network (OPTN), 15 from National Health Service (NHS), and 20 from National Kidney Foundation (NKF). Two native Spanish-speaking nephrologists, both of whom are of Mexican heritage, scored the translations for linguistic accuracy and cultural sensitivity tailored to Hispanics using a 1-5 rubric. The inter-rater reliability of the evaluators, measured by Cohen's Kappa, was 0.85. Overall linguistic accuracy was 4.89 ± 0.31 for GPT-3.5 versus 4.94 ± 0.23 for GPT-4.0 (non-significant p = 0.23). Both versions scored 4.96 ± 0.19 in cultural sensitivity (p = 1.00). By source, GPT-3.5 linguistic accuracy was 4.84 ± 0.37 (OPTN), 4.93 ± 0.26 (NHS), 4.90 ± 0.31 (NKF). GPT-4.0 scored 4.95 ± 0.23 (OPTN), 4.93 ± 0.26 (NHS), 4.95 ± 0.22 (NKF). For cultural sensitivity, GPT-3.5 scored 4.95 ± 0.23 (OPTN), 4.93 ± 0.26 (NHS), 5.00 ± 0.00 (NKF), while GPT-4.0 scored 5.00 ± 0.00 (OPTN), 5.00 ± 0.00 (NHS), 4.90 ± 0.31 (NKF). These high linguistic and cultural sensitivity scores demonstrate Chat GPT effectively translated the English FAQs into Spanish across systems. The findings suggest Chat GPT's potential to promote health equity by improving Spanish access to essential kidney transplant information. Additional research should evaluate its medical translation capabilities across diverse contexts/languages. These English-to-Spanish translations may increase access to vital transplant information for underserved Spanish-speaking Hispanic patients.
Collapse
Affiliation(s)
- Oscar A Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Shennen A Mao
- Division of Transplant Surgery, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Napat Leeaphorn
- Division of Transplant Surgery, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
- Department of Transplant, Mayo Clinic, Jacksonville, USA
| | - Pooja Budhiraja
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Iasmina M Craici
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Maria L Gonzalez Suarez
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
48
|
Bofao J, Bergh M, Zheng A, Sadarangani T. Dementia-Related Disparities in Adult Day Centers: Results of a Bivariate Analysis. J Gerontol Nurs 2024; 50:42-47. [PMID: 38569103 PMCID: PMC11187696 DOI: 10.3928/00989134-20240313-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE Adult day services (ADS) are a valuable resource for people living with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) and serve a large population of late-life immigrants, often with limited English proficiency (LEP). This secondary data analysis examined potential disparities in diagnosis, dementia severity, medical complexity, and dementia-related behavioral problems in persons with AD/ADRD with LEP within the ADS setting. METHOD The current study used data from TurboTAR, the electronic health record for ADS in California. Bivariate analyses were conducted to examine differences in clinical management for those with and without LEP. RESULTS Of 3,053 participants included in the study, 42.3% had LEP. Participants with LEP had higher rates of emergency department use and medication mismanagement. However, due to non-standard data collection, there was a significant amount of missing data on language preference (38.1%) and race/ethnicity (46.5%). Although these findings suggest LEP may play a role in the clinical management of persons with AD/ADRD in ADS, missing data caused by lack of standardized collection compromise the results. CONCLUSION It is essential to improve data collection practices in ADS on language, race, and ethnicity to help identify health disparities and promote equitable care for marginalized older adults. [Journal of Gerontological Nursing, 50(4), 42-47.].
Collapse
|
49
|
Mercado O, Nelin TD, Arias-Oliveras A, Montoya-Williams D. Inequities Faced by Children in Immigrant Families in United States NICUs. Neoreviews 2024; 25:e237-e244. [PMID: 38556495 DOI: 10.1542/neo.25-4-e237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Osvaldo Mercado
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Timothy D Nelin
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ana Arias-Oliveras
- Division of Pediatrics General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Diana Montoya-Williams
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
50
|
Kiarashi J, Halker Singh RB. Diversity, Equity, and Inclusion in Headache Care and Research. Continuum (Minneap Minn) 2024; 30:498-511. [PMID: 38568496 DOI: 10.1212/con.0000000000001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
ABSTRACT This article reviews the disparities faced by individuals who experience headache disorders and discusses potential solutions to deliver equitable care. Disparities exist in the diagnosis and treatment of headache disorders with regard to race, ethnicity, sex, gender, sexual orientation, geography, and socioeconomic status. Furthermore, research in the realm of headache disparities is inadequate, and the clinical trial representation of patients from underserved communities is poor. Many barriers exist to optimizing care for underserved communities and this article addresses these barriers and presents ways to combat them.
Collapse
|